Skin thinning → alopecia, poor hair regrowth, calcinosis cutis in severe cases
ADH antagonism → PU/PD and dilute urine
The NAVLE emphasis is not the pathway. It is recognizing the chronic pattern and not overcalling the diagnosis from screening abnormalities.
Pattern recognition
Core pattern
PU/PDPantingPot-bellied older dog
Supporting clues
PolyphagiaThin skin / poor hair regrowthBilateral alopeciaRecurrent UTIMarked ALP elevation
NAVLE trigger: The chronic “PU/PD + panting + pot belly” cluster is the signal. High ALP helps, but it is never the diagnosis by itself.
Decision core — what NAVLE actually asks
Classic stable suspect
→ Choose endocrine testing rather than diagnosing from routine chemistry alone
Dog receiving chronic exogenous steroids
→ Think iatrogenic hyperadrenocorticism before spontaneous disease
Confirmed pituitary-dependent disease
→ Trilostane is the board-style long-term answer with monitoring
Key interpretation
ALP
↑ Often marked
Common clue, not proof
Urine SG
Often low
Dilute urine with PU/PD
LDDST
Screen / diagnose
Frequently tested choice
CBC
Stress leukogram
Supportive, not diagnostic
Glucose
May be high
Cortisol drives insulin resistance
Iatrogenic clue
Steroid history
History can answer the question
⚠ Marked ALP elevation supports the pattern, but boards often punish diagnosing Cushing's from chemistry alone.
Treatment
PDH
Trilostane
Most common board answer for pituitary-dependent hyperadrenocorticism.
Monitor
Clinical signs + scheduled endocrine monitoring
Over-suppression can create an Addisonian picture, so monitoring matters.
Alt.
Mitotane or surgery for selected cases
The exam usually wants trilostane first unless it is clearly an adrenal tumor question.
NAVLE traps — where students lose marks
✕
High ALP does not equal Cushing's
It is common support, not confirmation. Test the patient with the right clinical pattern.
✕
Ask about steroid exposure
Iatrogenic Cushing's is a classic history-based board trap.
✕
Do not confuse with hypothyroidism
Both can have alopecia, but Cushing's gives PU/PD, panting, polyphagia, and thin skin.
✕
Treatment can overshoot
If therapy suppresses cortisol too far, the dog can look weak or Addisonian.
Differentials — how to separate these on NAVLE
Fast separator: Cushing's is the chronic PU/PD + panting + pot-belly dog. The board often contrasts it with hypothyroidism, diabetes mellitus, and steroid administration.
Disease
PU/PD
Skin pattern
Key separator
Cushing's disease
Yes
Thin skin / poor regrowth
Panting + pot belly + ALP up
Hypothyroidism
No / mild
Symmetric alopecia
Weight gain + lethargy, not classic PU/PD
Diabetes mellitus
Yes
Variable
Persistent hyperglycemia / glycosuria
Iatrogenic Cushing's
Yes
Thin skin
History of chronic glucocorticoids
Chronic liver disease
Variable
Variable
No classic endocrine testing pattern
Mini cases — apply the decision framework
Pattern recognition
11yr Poodle with PU/PD, panting, thin skin, and a pot-bellied appearance has markedly increased ALP. What disease should move up your list first?
→ Hyperadrenocorticism
This is the classic stable outpatient Cushing's pattern.
History trap
A dog with chronic pruritus on long-term prednisone now has polyuria, panting, and thin skin. What is the most likely explanation?
→ Iatrogenic hyperadrenocorticism
When the steroid history is obvious, the exam wants you to use it.
Therapy
A dog has confirmed pituitary-dependent hyperadrenocorticism. What long-term treatment is most commonly expected on NAVLE?
→ Trilostane
This is the common board-style answer for confirmed PDH.
Clinical application tools
Use these to sanity-check concurrent problems and medication planning. They do not replace endocrine case selection.
An older small-breed dog presents with polyuria, polydipsia, panting, polyphagia, and a pendulous abdomen. Which diagnosis best fits this overall pattern?
Correct answer: B. PU/PD plus panting, polyphagia, and pot-bellied appearance is the classic Cushing's cluster.
Q2History trap
A dog has been receiving prednisone for months for allergic skin disease and now shows thin skin, panting, and PU/PD. What is the most likely explanation?
Correct answer: C. This is a history-driven diagnosis. The steroid exposure explains the clinical picture.
Q3Next best step
A stable dog strongly fits the Cushing's pattern and has a markedly increased ALP. Which next step is most appropriate?
Correct answer: A. High ALP is support, not proof. The right move is endocrine testing in the right patient.
Q4Treatment
A dog has confirmed pituitary-dependent hyperadrenocorticism. Which long-term treatment is most commonly expected on NAVLE?
Correct answer: D. Trilostane is the most common board answer for confirmed PDH.
Q5Trap question
Which statement about routine laboratory abnormalities in canine Cushing's disease is most accurate?
Correct answer: C. Routine chemistry and CBC changes help support suspicion, but Cushing's still requires an endocrine workup.
